Swindon Intermediate Care Centre

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

This means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

This is the first assessment for this service. This key question has been rated as good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

We have not awarded this service a score for Effective.

Find out about when we will not publish a key question score and what we look at when we assess Effective.

The service did not always make sure people’s care and treatment were effective because they did not always check and discuss people’s health, care, wellbeing and communication needs with them.

The service identified and responded to people’s needs; however, staff did not consistently personalise care plans, update them promptly, or fully embed them in practice. Although systems to assess and review needs were in place, staff did not always use them effectively or reliably.

Review of seven care records showed that care plans were not always fully personalised. Staff had recently transitioned from paper records to an electronic system and were still developing confidence in using the templates.

Staff did not always update care plans promptly when people’s needs changed. However, they used daily handover sheets to record and communicate changes in people’s care and support needs.

The ward provided access to a range of specialists required to meet people’s needs; however, not all staff knew how to contact them.

Staff discussed people’s needs with them and involved them in decisions about their care and treatment.

Patients told us they were involved in setting, reviewing and updating goals as part of their rehabilitation with therapy staff.

We observed staff communicating patiently, kindly and compassionately with people, including those with mental health needs.

Staff offered patients pain relief when required.

The service planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards.

Staff followed up‑to‑date policies to plan and deliver high‑quality care in line with best practice and national guidance.

Therapy staff followed best practice guidance and completed individualised assessments that focused on collaborative goal setting and regular review.

The service promoted independence and rehabilitation, supporting people to regain confidence, daily living skills and functional ability. Patients and relatives confirmed this reflected their experience of care.

Staff used a range of rehabilitation equipment, which they assessed appropriately and tailored to meet each person’s individual goals.

The tissue viability team provided regular specialist input to support pressure ulcer prevention and wound care, including managing complex wounds and using specialist equipment.

Staff protected the rights of patients subject to the Mental Health Act and Mental Capacity Act and followed the relevant Codes of Practice.

Staff assessed patients’ pain using a recognised tool and gave pain relief in line with individual needs and best practice.

Staff discussed their training needs with their line manager and received support to develop their skills and knowledge. For example, managers supported one nursing associate to complete a degree nurse apprenticeship.

Managers supported nursing staff to develop through regular, constructive clinical supervision. They also provided additional support for newly qualified nurses and nursing associates.

Managers supported medical staff to develop through regular, constructive clinical supervision and appraisal of their work.

The service worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff accessed the information they needed to assess, plan and deliver people’s care, treatment and support effectively.

Staff held regular and effective multidisciplinary meetings, where they reviewed people’s care, treatment and risks. Professionals from all disciplines contributed to discussions and shared updates on people’s progress.

Teams developed effective working relationships with relevant internal and external partners. This included system‑wide partners, local care providers, local trusts, the local authority, discharge coordinators and commissioners.

Staff held daily huddles to discuss risks and identify people who required closer monitoring. They also used these discussions to identify safeguarding concerns and make referrals where required.

Staff told us that daily huddles were effective and supported shared decision‑making, particularly when concerns arose about changes in a person’s condition or observations.

We observed good collaboration and communication between staff of all grades and professions within the wards.

Staff worked closely with a local hospital to improve people’s transition of care from acute to community services. This included agreeing clear discharge summaries and ensuring staff had timely access to all relevant information before people were admitted to the service.

Most staff described relationships across the department and wider teams as cooperative, supportive and appreciative. However, three staff members told us that communication and clinical oversight could be improved.

The service supported people to manage their health and wellbeing to maximise their independence, choice and control. The service supported people to live healthier lives and where possible, reduce their future needs for care and support.

Staff supported patients to live healthier lives by providing exercise as part of therapy, which patients completed individually or as part of a group.

The service promoted the MEND campaign to support wellbeing through four simple daily actions: Move, Engage, Nourish and Dress.

Staff encouraged people to move regularly and remain physically active as part of their daily routine. Staff also supported people to engage and stimulate their minds, for example by discussing hobbies or memories and completing puzzles and other activities.

Staff focused on supporting people to eat and drink well. They encouraged regular intake, supported people to sit up for meals, and escalated any nutrition concerns to nursing staff.

Staff supported people to get dressed in their own clothes, helping them to feel comfortable and maintain their dignity.

Staff completed patients’ fluid and nutrition charts fully and accurately where required.

Staff used a nationally recognised screening tool to monitor patients at risk of malnutrition.

The service provided access to specialist support, including dietitians and speech and language therapists, for patients who needed it.

The service displayed relevant information on wards to promote healthy lifestyles and available support.

The service routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

The service implemented an annual clinical audit programme and reviewed it regularly at the quality assurance group to assess practice against agreed standards and drive improvement.

Managers used audit findings to improve care and treatment. A call bell audit demonstrated improved staff response times, with patients providing positive feedback about timely support. Staff answered call bells within five minutes in 86.65% of cases on Orchard Ward and 86% on Forest Ward.

Staff completed Infection Prevention and Control (IPC) cleaning audits regularly, and both wards achieved cleanliness scores above the 95% target.

The service maintained an ongoing programme of audits, including infection control, falls risk assessments, pressure ulcers and medicines management.

The service participated in relevant national clinical audits.

Managers shared audit results with staff and used them to improve outcomes.

Staff carried out repeated audits to monitor improvement over time. For example, a pressure ulcer audit identified learning needs; staff completed additional training and introduced a guidance tool to support identification, grading and reporting requirements to the Care Quality Commission and local authorities.

Leaders monitored improvement actions to ensure sustained progress.

Staff accessed electronic care records; however, some staff reported that systems were difficult to navigate, which could affect access to up‑to‑date information. Leaders recognised this risk and introduced care record audits and additional training, including drop‑in sessions and telephone support, to improve practice.

The service told people about their rights around consent and respected these when delivering person-centred care and treatment.

Staff took all practical steps to enable patients to make their own decisions. Staff ensured patients consented to treatment based on all the available information, and gained consent from patients for their care and treatment in line with legislation and guidance.

Staff understood how and when to assess whether a patient had the capacity to make decisions about their care and assessed and recorded capacity to consent appropriately for patients who might have impaired mental capacity. When patients could not give consent, staff made decisions in their best interests, taking into account patients’ wishes, culture and traditions.

Staff understood the relevant consent and decision‑making requirements set out in legislation and guidance, including the Mental Health Act, Mental Capacity Act 2005 and the Children Acts 1989 and 2004, and they knew who to contact for advice. Staff described how to access policies and obtain accurate advice on the Mental Capacity Act and Deprivation of Liberty Safeguards.

Most staff completed and maintained up‑to‑date training in the Mental Capacity Act and Deprivation of Liberty Safeguards. At the time of our assessment, staff achieved 87.5% compliance on Forest Ward and 82.8% on Orchard Ward.

People told us that staff “communicated well”, gave information clearly and checked understanding when gaining consent.